Pancreatic Cancer

What is pancreatic cancer?

Pancreatic cancer is the fourth most common cause of cancer death in the U.S. According to the American Cancer Society, about 44,000 new cases of pancreatic cancer and about 38,000 deaths are expected in 2011. Pancreatic cancer occurs when malignant cells grow out of control.

Risk factors for pancreatic cancer include:

• Age - most pancreatic cancer occurs in people over the age of 45.

• Smoking - heavy cigarette smokers are two or three times more likely than non-smokers to develop pancreatic cancer.

• Obesity and physical inactivity - pancreatic cancer is more common in people who are very overweight and in people who don't get much physical activity.

• Diabetes - pancreatic cancer occurs more often in people who have diabetes than in those who do not.

• Gender - more men than women are diagnosed with pancreatic cancer.

• Race - African-Americans are more likely than Asians, Hispanics, or Caucasians to be diagnosed with pancreatic cancer.

• Family history - the risk for developing pancreatic cancer is higher if a person's mother, father, or a sibling had the disease.

• Cirrhosis of the liver - people with cirrhosis have a higher risk of pancreatic cancer.

• Workplace exposures - exposure to occupational pesticides, dyes, and chemicals used in the metal industry may increase the risk of pancreatic cancer.

• Some genetic syndromes - certain inherited gene mutations, such as in the BRAC2 gene, increase the risk of pancreatic cancer.

• Chronic pancreatitis - long-term inflammation of the pancreas has been linked with increased risk for pancreatic cancer.

There are several types of pancreatic cancers, including the following:

• Adenocarcinoma of the pancreas - the most common pancreatic cancer, which occurs in the lining of the pancreatic duct.

• Adenosquamous carcinoma - a rare pancreatic cancer.

• Squamous cell carcinoma - a rare pancreatic cancer.

Some neuroendocrine tumors in the pancreas include the following - they may be benign (noncancerous) or malignant (cancerous):

• Insulinoma - a rare pancreatic tumor that secretes insulin, the hormone that lowers glucose levels in the blood.

• Gastrinoma - a tumor that secretes above average levels of gastrin, a hormone that stimulates the stomach to secrete acids and enzymes. Gastrinoma can cause peptic ulcers.

• Glucagonoma - a tumor that secretes glucagon, a hormone that raises levels of glucose in the blood, often leading to a rash.

What are the symptoms of pancreatic cancer?

The following are the other most common symptoms of pancreatic cancer. However, each individual may experience symptoms differently. Symptoms may include:

• Pain in the upper abdomen or upper back

• Loss of appetite

• Weight loss

• Jaundice (yellow skin and eyes, and dark urine)

• Indigestion

• Nausea

• Vomiting

• Extreme tiredness (fatigue)

The symptoms of pancreatic cancer may resemble other conditions or medical problems. Always consult your physician for a diagnosis.

How is pancreatic cancer diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for pancreatic cancer may include the following:

• Ultrasound (also called sonography) - a diagnostic imaging technique that uses high-frequency sound waves to create an image of the internal organs. Ultrasounds are used to view internal organs of the abdomen such as the liver, pancreas, spleen, and kidneys and to assess blood flow through various vessels. The ultrasound may be performed using an external or internal device:

  • Transabdominal ultrasound - the physician places an ultrasound device on the abdomen to create the image of the pancreas.

  • Endoscopic ultrasound (EUS) - the physician inserts an endoscope, a small, flexible tube with an ultrasound device at the tip, through the mouth and stomach, and into the small intestine. As the physician slowly withdraws the endoscope, images of the pancreas and other organs are made.

• Computed tomography scan (CT or CAT scan) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.

• Magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.

• Endoscopic retrograde cholangiopancreatography (ERCP) - a procedure that allows the physician to diagnose and treat problems in the liver, gallbladder, bile ducts, and pancreas. The procedure combines x-ray and the use of an endoscope - a long, flexible, lighted tube. The scope is guided through the patient's mouth and throat, then through the esophagus, stomach, and duodenum. The physician can examine the inside of these organs and detect any abnormalities. A tube is then passed through the scope, and a dye is injected which will allow the internal organs to appear on an x-ray.

• Percutaneous transhepatic cholangiography (PTC) - a needle is introduced through the skin and into the liver where the dye (contrast) is deposited and the bile duct structures can be viewed by x-ray.

• Pancreas biopsy - a procedure in which a sample of pancreatic tissue is removed (with a needle or during surgery) for examination under a microscope.

• Special blood tests

• Positron emission tomography (PET) - a type of nuclear medicine procedure. This means that a tiny amount of a radioactive substance, called a radionuclide (radiopharmaceutical or radioactive tracer), is used during the procedure to assist in the examination of the tissue under study. Specifically, PET studies evaluate the metabolism of a particular organ or tissue, so that information about the physiology (functionality) of the organ or tissue is evaluated, as well as its biochemical properties. Thus, PET may detect biochemical changes in an organ or tissue that can identify the onset of a disease process before anatomical changes related to the disease can be seen with other imaging processes such as computed tomography (CT) or magnetic resonance imaging (MRI).

Treatment for pancreatic cancer

Specific treatment for pancreatic cancer will be determined by your physician based on:

• Your age, overall health, and medical history

• Extent of the disease

• Type of cancer

• Your tolerance of specific medicines, procedures, or therapies

• Expectations for the course of the disease

• Your opinion or preference

Depending upon the type and stage, pancreatic cancer may be treated with the following:

• Surgery - may be necessary to remove the tumor - a section or entire pancreas and/or the small intestine. The type of surgery depends on the stage of the cancer, the location and size of the tumor, and the person's health. Types of surgery for pancreatic cancer include the following:

  • Whipple procedure - this procedure involves removal of the head of the pancreas, part of the small intestine, the gall bladder, part of the stomach, and lymph nodes near the head of the pancreas. Most pancreatic tumors occur in the head of the pancreas, so the Whipple procedure is the most commonly performed surgical procedure for pancreatic cancer.

  • Distal pancreatectomy - if the tumor is located in the body and tail of the pancreas, both of these sections of the pancreas will be removed, along with the spleen.

  • Total pancreatectomy - the entire pancreas, part of the small intestine and stomach, the common bile duct, the spleen, the gallbladder, and some lymph nodes will be removed. This type of operation is not done often.

  • Palliative surgery - for more advanced cancers, surgery may be done not to try to cure the cancer, but to relieve problems such as a blocked bile duct.

• External radiation (external beam therapy) - a treatment that precisely sends high levels of radiation directly to the cancer cells. The machine is controlled by the radiation therapist. Since radiation is used to kill cancer cells and to shrink tumors, special shields may be used to protect the tissue surrounding the treatment area. Radiation treatments are painless and usually last a few minutes. Radiation therapy may be given alone, or in combination with surgery and/or chemotherapy.

• Chemotherapy - the use of anti-cancer drugs to treat cancerous cells. In most cases, chemotherapy works by interfering with the cancer cell’s ability to grow or reproduce. Different groups of drugs work in different ways to fight cancer cells. The oncologist will recommend a treatment plan for each individual. Chemotherapy may be given alone, or in combination with surgery and radiation therapy.

• Medication (to relieve or reduce pain)

Long-term prognosis for individuals with pancreatic cancer depends on the size and type of the tumor, lymph node involvement, and degree of metastases (spreading) at the time of diagnosis.